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Author
Topic: Abrupt change in numbers after a short time (Read 11470 times)

A little history, I was dx on April 10,2013. First blood drawn on May 3rd, at that time t-cell count was 109 VL was 104K. More blood drawn on 06/04/2013 t-cell count was 80 VL was 85K.

I started on Truvada/Isnetress on 07/20/2013

On 8/29 blood drawn, only did VL, it was 20< aka Undetectable. No t-cell count done at that time.

I know everyone talks about how great the new meds are but that seems like a drastic drop in a very short time? My Dr appointments isn't till 10/17. So I was just wondering if anybody else had experienced a drastic drop in VL like that when first starting meds?

Viral load drops a log in a few days and another log over a week. That's what my doc said. I had millions of hideous virons and the morning after my first does my body was calm and I felt like I had been massaged all night...

Anyway, congrats. Now the CD4 rebuilds. Patience if its not s brilliant as your viral load success....

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ďFrom each, according to his ability; to each, according to his needĒ 1875 K Marx

Thanks for all the encouragement y'all. Since I originally posted I've taken a leave from work due to stress. I've gotten in to a routine of walking every morning. I mapped out a mile in my neighborhood and make an effort to walk every day. As my time improved I worked up to 1.5 miles and feel great. Still fighting with my short term disability insurer. But haven't told them about my status yet, just going with the stress issue.

In other words, if you would start meds with 1 CD4 count (for the sake of example), you'd be UD almost instantly, since there are virtually almost no CD4 in line for programmed death

that's not so true. Well maybe it's just a bit of hyperbole.

I started with 5 cd4s and went 12 yrs before reaching UD. During those years, my cd4s averaged about 95 with a high of 245. Now, 21+ yrs of meds later, my cd4s just barely hit over 300 while I have remained UD (for the most part. there have been a few real spikes of well over 1k). Of course I'm sure my story is impacted by the efficacy of those early medications I was on.

However, I'll grant you that after starting ART the viral load will usually begin to fall dramatically, but saying "instantly UD" is a bit of an overstatement. The meds now are amazing and work pretty dang quick; but not that quick. As evidenced by most of the stories told here (including the OP's own post), having a high viral load, no matter the CD4 count, and reaching UD usually takes about 3-6 months.

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leatherman (aka mIkIE)

All the stars are flashing high above the seaand the party is on fire around you and meWe're gonna burn this disco down before the morning comes- Pet Shop Boys chart from 1992-2015Isentress/Prezcobix

I was obviously referring to successful HAART, since the OP went UD within time.

VL is measured and monitored to confirm that the combo is not inefficient. Anecdotal account of inefficient combos, despite otherwise interesting and instructive, are out of scope of the OP's case.

That being said I do not take back what I said , that , in general (exception do unfortunately occur) the lower the CD4 count at initiation the faster the second phase of decay (given an efficient combo)

The second phase is the key contributor to time-to-UD (since first phase is very fast and third phase is considered to occur below UD levels)

If no replication occurs during the second phase, then VL decay is only driven the death rate and infectious rate of previously infected CD4s (macrophages can be ignored as their contribution to VL is marginal). Where else could it come from ?

For a given infectious rate and a constant death rate in the second phase estimated at a half life of 15 days, the less previously infected CD4 you have the faster to UD you go

This is very visible on numerous accounts of posters in this forum who went on a successful combo and started at fairly low levels (say < 200) (including the OP)

This is very visible on numerous accounts of posters in this forum who went on a successful combo and started at fairly low levels (say < 200) (including the OP)

yes, I agree. I even pointed that out. However those posters, with varying degrees of VLs and CD4 counts, were reporting reaching UD within an approx 3-6 month time period, not "instantly".

No matter how it's sliced though, no one goes UD "instantly", no matter how low their starting cd4. The time might be shorter in cases with low cd4s; but in a better/best case scenario, taking 8 weeks (or even less) is still not "almost instantly". I think that's just a bit too much hyperbole.

For instance, when people complain about some of the general adverse side effects that (can) accompany starting a new regime (ie nausea, diarrhea), I often counsel that they at least try to get past 2-4 weeks. It takes that kind of time to adapt (for the amount of ART to reach peak and constant in your system, and for your viral load to decrease lessening the generalized HIV effects). I would never suggest - although 2-4 weeks is hardly a blink in a lifespan - that someone's side effects would be over "almost instantly". In the same way, I don't think that taking 8 weeks to reach UD is "almost instantly". Two months (or more) can feel like and can be a pretty long time.

what I'm saying is that while people should clearly expect to reach UD in a very short amount of time when on successful ART, they shouldn't expect it to happen overnight (and that's still even longer than "almost instantly" LOL); but do expect it to happen within several short months.

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leatherman (aka mIkIE)

All the stars are flashing high above the seaand the party is on fire around you and meWe're gonna burn this disco down before the morning comes- Pet Shop Boys chart from 1992-2015Isentress/Prezcobix

actually being an optimistic realist, I feel that my VL "is measured and monitored to confirm that the combo" IS "efficient".

Unfortunatly, in terms of pure logics, what is being checked is that the combo is not unefficient.

If it where to confirm that is is efficient (at the individual level, not in cohort or double blinded), then we would know from VL HOW efficient it is (at the indididual level, by monitoring VL only). Unfortunatly , that we can't (as proven by Siliciano)

If the combo cannot be deamed inefficient within a given time frame, then it is assumed efficient.

But, in terms of pure logics, what is being tested is double negative hypothesis.

The hypothesis is that the combo does not work

If the decay goes down, logarithmically and down to UD, that hypothesis is then invalid and thus the combo considered efficient

At any rate, within the group of potent combos (individual and cohort/trial levels), it is not possible to claim that one is more potent than an other on the sole basis of VL decay and time to UD. That question was raised since, RAL apparently provides a faster decay, but that is not a proof of higher potency (here again refer to Siliciano's work)

What can be done, nonetheless is non-inferiority validation, which here again is a double negative.

Viral load drop is not faster/slower by CD4 count at start of treatment. The same is true for time to undetectable. The two things are completely unrelated, and to relate them is a fundamental misconception in the biology of HIV infection.

Plus, how fast/slow you go to undetectable makes no difference to long term outcomes.

How fast you get UD seems to depend on the drug combo you are on. I've read articles about Stribuild and it was achieving UD in about a month for most subjects. Seems that combos that have Integrase Inhibitor in them achieve UD in about a month, no matter what the VL or CD4 was before treatment.

My own experience: VL 76000 to UD in one month on Stribild. CD4 initially was 60.

Our model predictions have important implications for the motivation behind the use of raltegravir and our understanding of the virus-producing cells of the second-phase viraemia. Our results also highlight that the viral dynamics produced by different antiretroviral drugs should not be directly compared with each other.

(emphasis by me)

This one here is excellent ( really excellent research)A quantitative basis for antiretroviral therapy for HIV-1 infection, by Siliciano and al

My own experience: VL 76000 to UD in one month on Stribild. CD4 initially was 60.

Which you attribute to ... Stribild ... or initial CD4 of 60 ... ?

Back to the remark I made that people starting with very low CD4 have a faster decay, I did not make that up by myself. I guess it came into one conversation I had about something else with one researcher.

Therefore, I questioned her about my 'fundamental misconception'...

I was not vexed because the poster of that remark is in no known standing or position to make this kind of judgment , but, she was !

So she went thru her files to get me a series to work on. I just got the data and, well... as you might expect...

I had a first peep at the data, I'll get them into a graphic form. and post it next week

It is very graphic! and we even have a patient starting at CD4 = 1 in the data set !

In the meantime, poster of 'fundamental misconception' fairly derogatory remark will have time to reflect on her own words and how they may affect her own reputation. Me, I do not take offense... Who am I to judge people?

Stay tuned. My post, under construction, on low CD4 at initiation and faster decay is a killer

Actually my CD4 was 60 and VL was 76000 when I was diagnosed. Then I did a month on herbs and my VL dropped to 60000, CD4 jumped to 140. I don't know if that was a rebound or the fact that the chlamydia I had for months (which made me go for check up and then I got a poz hiv test) was finally treated and cured OR it was due to the herbs. That was the most impressive increase in CD4 I've experienced per month so far.

Figure 2 in the article shows that at 4 weeks, 60% of subjects on Stribild are UD. The proportion of patients with starting CD4<200 was just 15% (Table 1) so the explanation that Stribild makes subjects UD in a month only for those because they have low CD4 doesn't hold water.

I don't think the effectiveness of Stribild has anything to do with the CD4.

HIV meds do NOTHING directly to your cd4 count. However, it IS the effectiveness of a medication that reduces the amount of virus and allows the immune system to recover and cd4 count to rise

To what point a cd4 count will rebound and how fast cd4s rebound is purely an individual genetic trait. It has been shown though that for people whose cd4 nadir (the lowest point) is very low, it takes a longer time to rebound and the rebound usually doesn't reach previous "normal" levels. (BTW, "normal" cd4 levels are anywhere from 500-1500. Unless a person had a PRE-hiv cd4 count test then there is really no way to know what that person's "normal" level was.)

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leatherman (aka mIkIE)

All the stars are flashing high above the seaand the party is on fire around you and meWe're gonna burn this disco down before the morning comes- Pet Shop Boys chart from 1992-2015Isentress/Prezcobix

Herbs actually influence both viral load and CD4, that is clear from my own case of 1 month on herbs. In that month on herbs I experienced the fastest and largest jump in CD4, not in the months that followed on Stribild or Complera. I also know a hiv poz guy that keeps his VL low entirely with herbs and he is not a "non-progressor". When he increased his intake of Olive Leaf, his viral load dropped even further (currently he is VL 300 and CD4 400). Olive Leaf is actually proven in an 'article' to have anti-hiv effect.

The problem is that herbs are not as potent or fast acting as the big pharma drugs and since I was running out of time, and not sure what combo of herbs to use in what doses, I switched to drugs.

Leatherman please read the thread before you comment on it. The argument in this thread is whether the INITIAL CD4 actually has something to do with the INITIAL effectiveness of Stribuild (how fast UD is achieved). Your comment on how drugs affect CD4 really has nothing to do with it and is another example of your brain scattered generalities. Maybe take a pill to help with that ...

Herbs actually influence both viral load and CD4, that is clear from my own case of 1 month on herbs. In that month on herbs I experienced the fastest and largest jump in CD4, not in the months that followed on Stribild or Complera. I also know a hiv poz guy that keeps his VL low entirely with herbs and he is not a "non-progressor". When he increased his intake of Olive Leaf, his viral load dropped even further (currently he is VL 300 and CD4 400). Olive Leaf is actually proven in an 'article' to have anti-hiv effect.

The problem is that herbs are not as potent or fast acting as the big pharma drugs and since I was running out of time, and not sure what combo of herbs to use in what doses, I switched to drugs.

Leatherman please read the thread before you comment on it. The argument in this thread is whether the INITIAL CD4 actually has something to do with the INITIAL effectiveness of Stribuild (how fast UD is achieved). Your comment on how drugs affect CD4 really has nothing to do with it and is another example of your brain scattered generalities. Maybe take a pill to help with that ...

Leatherman was right . And I certainly hope no one takes you seriously because what you claim is not true . There are no herbs that lowers the viral loads in HIV positive people period .

Also think very carefully before deciding to post links to any bogus site that attempts to back up the false impression you have been giving out about diet , exercise and herbs impacting the outcome of an HIV infection . Its a given that eating well and exercise does a body good but its not going to save you from HIV.

When your said the problem is that herbs are not as potent or fast acting as the big pharma drugs its misleading and potentially harmful and simply not true .

The only thing that you can use to successfully treat an acute HIV infection is ART . You are warned .

True miss Pricilla but this is not simply 'correlation'. It's reduction of my VL by 20% after one month of herbs and some antibiotics for the chlamydia. Also the poz guy I know upped his olive leaf by 1.5 grams and his VL dropped from 6000 to 300. This in statistics is called 'treatment' not just correlation and proves casual relationship - that's how the big pharma drugs are proven too.

I want to make clear I do not advise anyone here to get on herbs because its uncharted territory and is simply not for most of you. We all know what happens in Africa with people that use herbs instead of the big pharma hiv drugs - they are dying in millions.

On the other hand, denying FACTS from my own and other people experience with some absolutist negative statements that "no herb can lower VL" sounds a bit like a brain washed cult of zombies to me.

Below is the paper showing that OLIVE LEAF can inhibit HIV in vitro. This is not 'some site' but actual scientific paper with clear methodology. Now I'm sure it 'doesn't exist either'. ..

actually if any med combo, the thread is about Truvada/Issnetress. Maybe you need to reread the thread However, the thread is actually about how quickly ART can work to reduce VL which allows the CD4s to recover. My contribution was to say that yes VL can drop quickly and CD4s can rise quickly (although not by any stretch does this occur all the time) but that this improvement doesn't happen "instantly".

Maybe you need to re-read the thread because Stribuild is an Integrase Inhibitor combo like Isentress+Truvada. I posted an article about Stribuild illustrating the idea that Integrase Inhivitors achieve UD in one month.

Maybe draw a diagram while you are reading cause clearly you are not getting anything in this thread and are simply polluting the conversation with senile idiotism. Someone had to tell you ...

Maybe you need to re-read the thread because Stribuild is an Integrase Inhibitor combo like Isentress+Truvada. I posted an article about Stribuild illustrating the idea that Integrase Inhivitors achieve UD in one month.

Maybe draw a diagram while you are reading cause clearly you are not getting anything in this thread and are simply polluting the conversation with senile idiotism. Someone had to tell you ...

We do not allow name calling on the forum Witch . Do it one more time and you will be given a time out .

Obviously olive (I love both the black and green types!) leaf after another decade hasn't proven yet to be our saviour against HIV.

If you made the effort to actually lead the article and related ones from the same group, olive leaf has compounds that are Integrase and Fusion Inhibitors for HIV. This is where the contemporary research is currently is.

Even if olive leaf was potent enough, clearly big pharma has no interest investigating naturally occurring compounds because it cannot patent it and sell it for diamonds like they are doing with the latest hiv drugs. Nevertheless, olive leaf DOES LOWER VIRAL load. Educate yourself a little more before making sweeping negative statements about all herbs on Earth of which you obviously know nothing.

True miss Pricilla but this is not simply 'correlation'. It's reduction of my VL by 20% after one month of herbs and some antibiotics for the chlamydia. Also the poz guy I know upped his olive leaf by 1.5 grams and his VL dropped from 6000 to 300. This in statistics is called 'treatment' not just correlation and proves casual relationship - that's how the big pharma drugs are proven too.

Not sure what university you took statistics at but you should ask for a refund on your tuition. A 20% difference on a population (n) of 1 is not statistical correlation. And your assertion that this is how big pharma (or science in general) applies statistics to reach it's conclusions is an absurd bastardization of reality and really discredits you. Name calling only further erodes your credibility.

I actually teach statistics at university level so know and understand very well how statistics is being used by big pharma. I also understand that two anecdotal reports and some articles proving the biochemistry may not be a 'statistical proof' but to me it's enough evidence of effect.

I will leave the 'double blind placebo controlled study' to someone like you with lots of faith in the statistical methods ....

And before I forget, I presented way more evidence that Olive Leaf lowers VL, than the group here that was claiming that "no herb can lower VL".

You didn't you reproach THEM for proving their statement with a population of ZERO subjects? Now I wanna see how you guys are gonna conduct a "double blind placebo controlled" study on ALL herbs on Earth that they don't lower the VL....

If any of you actually studied logic you would have known that negative statements are impossible to prove because you have to exhaust all infinite possibilities.

Do they really let you teach . The reason we are not arguing our point with you is we are embarrassed for you . You have proven that you can read old research , now its time to master understanding it . Just do yourself a favor and knock off this foolishness .

Went to doc today for first labs. Started at 32 CD4s & 3.5million. Started Stribild and after only 7 weeks, 159 CD4s & VL 152! Doc said I have an incredible immune system and response to the meds. Every individual is different.

Had to share....Stribild ... Doc said I have an incredible immune system and response to the meds. Every individual is different.

And every individual has a different insurrance ;-) . I would love to have yours. I am considering this matter seriously. Can you share which insurrance is covering the costs. Appreciated . Good to know you are doing fine and BTW, Welcome to the forums! Eric

Well to follow up my short term disability was denied, but I was able in the 6 weeks I was off to continue my walking program and increase it as well. Just did blood work again VL 40< cd4 went from 80 to 184 my Dr was pleased almost as much as I was! In the process of the exercise I managed to drop about 15#'s. I was also having issues with liver enzymes approaching the 200 mark, but 1 dropped to the "normal" range of the lab they use and the other dropped to within 1 pt of normal (40-50 range)I started back to work today and I'm hoping I can keep up my exercise routine and expand it. Saw the shrink while I was out and he upped my Prozac and my Dr switched me to the 1 a day version of Isentress. The only noticeable side effect I've had is tinnitus. Dr asked if it was life altering, I figure if that's the worst I have to put up with, then I can live with it. Thanks for all the support and feedback!